While many cases of jaundice are benign, newborns must be continuously monitored to identify those who might develop severe hyperbilirunemia and, in rare cases, acute bilirubin encephalopathy or kernicterus (risk of permanent brain damage).
In the management of jaundice, the ability to screen easily and treat effectively is crucial to newborn health. It requires an approach that is:
Screening protocols and phototherapy can help provide the best care for each infant. Jaundice screening requires a technique that is noninvasive to minimize stress on the baby, yet it also needs to work instantly—and on all skin types—to ensure there is no delay in treatment and every infant receives the appropriate treatment.
The measurement of TSB and TcB levels for many, if not all, infants before discharge is becoming a common practice in the United States. In fact, it is recommended by the American Academy of Pediatrics as the best-documented method for predicting the likelihood of subsequent hyperbilirubinemia which can then reduce readmission rates.
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This short animated clip covers the basic overview of serum bilirubin testing and TcB screening. Screening does not replace serum bilirubin testing but with proper training and protocols, screening can extremely beneficial for infants and staff.
Dr. Sgro presents everything from background information to screening and therapy recommendations.
of healthy newborns develop jaundice.1
In preterm infants, almost every baby is affected.
1Source: Keren et al. Arch Dis Child Fetal and Neonatal Ed. 2009;94: F317-F322 and Bhutani et al. J Pediatr 2013:162;477-482
Most babies are discharged from the hospital much earlier than 4 days which is why it is important to recognize bilirubin levels could peak as late as the 4th day.
Hyperbilirubinemia is the most common reason for readmission in the first month of life.
TSB testing is the standard for bilirubin measurement which is measured directly from a blood sample and must be obtained with a heel stick procedure. TcB screening non-invasively measures bilirubin levels in the skin to provide an estimate of the TSB level. If TcB measurements reach a certain level*, a TSB test is required.
*Protocols and guidelines are defined by neonatal societies, hospitals or clinics.
TcB is now being used beyond the hospital in a community setting. Midwifery clinics from around the world have incorporated jaundice screening devices into their practice.
Reports from Children's hospitals & midwifery clinics. Click the spots on the map!
“Our patients’ parents seem to be pleased with the idea of an alternative to a heel stick when a heel stick might not be necessary.”
“It has been immensely valuable to be able to have immediate results instead of having to wait several hours.”
“Our two audits using the transcutaneous5 bilirubinometer showed a good acceptance of the bilirubinometer, a reduction in blood test requirement of five fold and a reduction in use of phototherapy in the postnatal wards.”
5Transcutaneous: Not going underneath the skin
“We like to measure the sternum4, it’s easy to access and the child can stay in the mother’s arms.”
4Sternum: the breast bone
“I plotted the results of the jaundice meter, versus the serum bilirubin levels for our low risk, mainly caucasian population. The result was a correlation that we are really satisfied with.”
Jaundice is commonly treated with phototherapy. The blue light helps reduce high levels of serum bilirubin. According to the clinician’s decision, a blood transfusion is used when the bilirubin level is at a high level.*/**
*Defined level according to protocols or guidelines set within a specific hospital or clinic
**Bilirubin can accumulate in the gray matter of the central nervous system, thus causing a brain dysfunction called Kernicterus."
The liver of a newborn often has a low detoxitation capacity. Treatment to reduce bilirubin is usually required if a newborn icterus occurs in the first day of life.
Phototherapy has proven to be a reliable method in the treatment of high bilirubin levels. Light helps to break down the bilirubin and transform the bilirubin into a water-soluble state through a photochemical reaction. This transformation enables precipitation by the gall bladder and kidneys.
Use the resources in this section to learn more about the use of phototherapy in the treatment of jaundice.
Approximately 10 percent of newborns have high bilirubin levels that require phototherapy treatment to avoid bilirubin encephalopathy. But it's not enough to place blue light above jaundiced preemies. Watch this video to learn more about three important factors for effective phototherapy.
Guidelines have been developed all over the world. Here are some for reference.